A premature newborn is a newborn born before the end of 37 weeks of amenorrhea. It is immature and therefore fragile. Major premature surgery concerns complications of prematurity and congenital malformations. Surgery alone is a factor in morbidity and mortality. Also, the association between emergency surgery and prematurity constitutes a double factor of morbidity which further affects the prognosis. The absence of epidemiological data on surgery for premature babies in our country led us to conduct this study, the objective of which is to determine the prevalence of surgical conditions in this population at risk, to identify the various pathologies and to assess morbidity and mortality at the Centre Hospitalier Universitaire Mère-Enfant Fondation Jeanne Ebori (CHUMEFJE).

Patients and Methods

We carried out a retrospective and descriptive study over a period of 2 years, from January 1, 2019 to December 31, 2020. The study took place in the neonatal medicine and pediatric surgery departments of the CHU Mère-Enfant Fondation Jeanne Ebori. It is a level 3 health structure located in the political capital Libreville whose hospital activity began on December 29, 2018. The neonatal medicine service has a capacity of 50 places. During this period, we included all premature babies having presented a surgical emergency, whether operated or not. The parameters studied in the newborn were: Gestational age (WA), birth weight, sex, different surgical pathologies, time to treatment, surgical treatment, length of  hospitalization and evolution. Data were collected from patient medical records and operating room registers. They were entered and analyzed in Excel 2013.

This work has been reported in line with the STROCSS criteria [1].

During the study period 466 premature newborns were admitted to the neonatal medicine department of CHUMEFJE. The number of newborns who presented surgical emergencies was 89, including 34 premature newborns, i.e. a prevalence of 7.3% (n = 34/466) and 38.2% of all neonatal emergencies (n = 34/89).

Surgical emergencies in premature newborns represented 12.4% of all surgical emergencies at CHUMEFJE. The mean maternal age was 28.1 years with extremes of 15 and 43 years. The mean gestational age was 32 weeks +3 days with extremes of 28 and 36 weeks + 6 days. The distribution of prematurity was 26.5% for extreme prematurity and 73.5% medium prematurity. The average weight was 1918.2gg with extremes of 600g and 4050g. The birth weight was less than 2500g in 85.3%, between 2500-4000 in 14.7%. Half of the newborns were male in with a sex ratio of 1 (Table I). Digestive pathologies represented 88.2% of surgical emergencies (Figure 1). Surgical pathologies were dominated by ulcerative necrotizing enterocolitis (41.2%) and duodenal atresias (Figure 2). Twenty out of thirty patients were operated on. The average time to surgical management was 5 days with extremes of 0 and 0 days. The average length of hospital stay was 8 days with extremes of 1 and 26 days. Overall mortality was 50%, dominated by ulcerative necrotizing enterocolitis (41.2%), esophageal atresia (23.5%). The mortality rate was the same after surgery or under medical treatment (50%) (Table 2).

The aim of this study was to determine the prevalence of surgical conditions in preterm infants and to assess their morbidity and mortality. The retrospective nature and the paucity of data in the literature on the subject somewhat limited our approach.

Nevertheless, we found a prevalence of 37% of premature newborns among total neonatal surgical emergencies. This is double the prevalence reported by Boumas et al. which found a prevalence of 19% [2]. This difference could be explained by the fact that the CHUME is currently and since its opening the reference center for mothers and children and that it brings together all of the country's pediatric surgeons.

The birth weight was less than 2500g in 85.3% Ndour [3] in Senegal found 53% of patients with a weight less than 2500g. the vulnerability of prematurity lies in its immaturity and low weight, which represents nearly three quarters of our sample.

Digestive emergencies represented 88.2% of the surgical conditions identified. This prevalence is well above those reported in Libreville (47.6%) Cocody (55%) and Yopougon (58.3%) [2,4,5]. Our study was specifically interested in the case of premature newborns who have the particularity of having immature organs, particularly in the digestive system.

Table 1: Newborn Parameters

Table 2: Mortality by Type of Pathology

Figure 1: Breakdown of Surgical Pathologies by Device

Figure 2: Breakdown by Type of Pathology

Ulcerative necrotizing enterocolitis, which is a direct complication of prematurity, was the most frequently found surgical condition (41.2%). Schonnerr-hellec in Angers also states that ulcerative necrotizing enterocolitis is the most frequent medical and surgical emergency in premature infants [6].

The mean time to surgical management was 5 days, a delay also described by Ralahy and Takongmo [7,8]. In fact, in developed countries, antenatal diagnosis allows treatment from the first hours of life, which significantly improves the prognosis. Keita [9] in his series found 64.86% of newborns with more than 7 days of life on admission, he blames the ignorance of these pathologies by practitioners, the delay in diagnosis and home deliveries.

On the evolutionary level, we found an overall mortality of 50% and a postoperative mortality of 26.7%, Mieret in Ivory Coast found respectively 58.2% and 8.79%. The significant difference in postoperative mortality in our context could be explained by the selectivity of our sample on prematurity, but also by the delay in taking charge of the patient and finally by the inexperience of the staff in the treatment of these cases. patients. While Ouedraogo [10] in Burkina Faso describes 30.3% and 32.35%. In their context, postoperative mortality is still higher than that found at the CHUME. 

In the sub-Saharan countries, mortality remains high, especially in Libreville in 2017 where it was 54.7% overall and 34.7% postoperatively, slightly above that which we found. In the DRC, on the other hand, overall mortality was lower, ie 43.3% [11]. This mortality can be explained by the delay in diagnosis and treatment, but also by the lack of the neonatal resuscitation technical platform in developing countries.

Surgical emergencies in premature newborns are dominated by digestive disorders, the first of which is ulcerative necrotizing enterocolitis.

The time taken to take charge is often long because of the diagnostic delay. Mortality is very high. A multidisciplinary collaboration between obstetrician gynecologists, neonatologists, pediatric surgeons and resuscitators would shorten the diagnostic time and would certainly improve treatment.

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